I recently traveled to Spain and took a guided bus tour. I learned during that tour about the work hour restrictions for bus drivers in Spain. It made me think about the lack of work hour restrictions for attending physicians in the United States. We have them for residents, but not attendings. After much thought, I decided to write about that experience and it was published on KevinMD today. Here is an excerpt:
There has been much talk over the years about resident work hours. How long is a safe shift? Safety being considered for both the patient and the resident. But no one ever discusses attending work hours. If putting in a 24 hour shift is bad for a resident, isn’t it bad for an attending as well? When I was working in critical access hospitals, I usually was on call for seven straight days or 168 hours. There was the potential for a long stretch of continuous work during that 168 hours, especially since there was no other doctor to cover for me if it got busy. Was my safety or my patient’s safety at risk if I worked more than 24 hours straight?
My wife and I just finished a guided bus tour of Spain and Portugal. One day our bus driver was switched for our evening of dinner and a late flamingo dancing show. I inquired about the change and this is what I discovered.
Our usual bus driver had already been on the job since early morning that day. If he were to pick us up from our evening entertainment, he would exceed his allotted working hours for the day and would get a huge fine, $2,000. Spain feels the bus driver has such an important position for the safety of his passengers that he is only allowed to drive 9 hours in a day or be on the job 15 hours, whichever comes first. Also, he is only allowed to work 6 days in a row and must then take a day off.
“How is this enforced,” I asked. There is a little black box on all of the buses that the driver must log into at the beginning of the day and log out when he finishes working. It keeps track of the number of hours he is working, the number of hours the bus is moving, and the number of consecutive days he drives. If the bus is moving, the black box is recording it. There is no way to fudge the hours he works and the bus can be stopped at any time by an official and have the black box analyzed. If he exceeds his allotted time by even one minute, the full fine is imposed.
If you would like to read the full article, and hear my take on how this applies to attending and resident physician work hours, you can go to KevinMD and read it here. Come back and comment on how you feel about working hours and what should be done. Forward this to all your friends and let’s get the conversation going. Maybe it’s time for a change.
This is so critical, yet so ignored. I have worked as a commercial pilot, and that activity has extremely regulated hours. Currently working the summer as a fire pilot (flying a plane that drops fire retardant), and again, our hours are limited. (Example: We can only be “on duty”, i.e., at the base, for 14 hours. Maximum flight time is 8 hours…which is rigidly enforced).
I am also an anesthesiologist and am board certified in OBG as well. Anesthesiology isn’t as physically hard as OBG. However, either practice is MUCH harder than flying.
If the federal regulators have determined that fatigue is so critical in performance of a duty that isn’t nearly as demanding intellectually as being a physician, why do we ignore this completely in the practice of medicine? (granted, we limit resident hours, at least on paper, but the pressure in the practice of medicine, both in academia and in private practice, is on the physician to work far more than a 14 hour day of “call time”, and 8 hours of actual work.)
Thank you for bringing this up.
Thanks plane doc,
It is surprising how fatigue is only important in a few industries. It either effects performance or it doesn’t. If it effects performance negatively, then it should be applied across the board.